Patients Define Their Emergencies (Part 2)

True Story…

The dispatch information was updated before we had even rolled our rig out onto the pad. Eye injury, no serious symptoms. Jodie shut down the lights and I informed dispatch that we’d be responding non-emergent.

Up stairs and inside the small two bedroom apartment, Samantha, our patient, was waiting on the couch, holding a hot compress to her swollen right eyelid. Mom worked calmly in the kitchen finishing diner for her other two children. Alan, Samantha’s father sat on the edge of his seat next to his daughter in a state of barely containable anxiety.

He had recently arrived home from work and his wife had informed him of the apparent infection in Samantha’s right eye. One look and he was on the phone to us. Now he breathed rapidly as he fumbled through a list of questions. What caused it? Could it damage her vision? Could she lose her eye? Could she go blind?

I cleared the engine to go back in service and sat down next to him. Over the next ten minutes we both explained what pink-eye was and how to take care of it. We talked about hot-compresses and how contagious the bacteria was going to be. We reviewed the typical course for such and infection. How to prevent it in the other kids. How likely it was that one of them already had it. And we discussed his plan for morning. (It involved asking a neighbor to drive them to a near-by clinic.)

Alan called 911 for pink-eye. And…(This part is bound to be controversial, depending on what kind of system you work in.) I never offered to take him to the emergency room. And he never asked.

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Don’t Be A Jerk

I didn’t draw the graph at right. It was made by a woman named Jessica Hagy over at www.thisisindexed.com. Jessica is not in the medical profession. She draws her observations about the world on index cards and posts them online.

She also has a long and growing list of blogging awards from around the world. Mostly due to her brilliantly irreverent style and her ability to make social observations that resonate with people.

Like this one.

It’s a sad but true observation. For some reason, it seems like many medical personnel have an interesting combination of helpfulness and jerkiness. Why do you suppose that is? I’ve thought a lot about that over the years.

I think a friend of mine, Steve Brien put it best when he said, “Some of us still have a lot of us still in us.”

Our profession is about the patient. It’s not about us. Remembering that simple fact, and keeping it at the forefront of our thoughts, isn’t as easy as it might seem.

The Ultimate EMS Protocol

I don’t handle the card much anymore. It stays inside a plastic sleeve in my planner. The edges are worn and the words are faded. It wasn’t printed on kind of paper that travels well in a wallet for twenty plus years. But it’s been worth carrying. It is, quite simply, the ultimate EMS protocol.

I don’t read it often. I’ve read it enough times over the past two decades to have it pretty well memorized. It’s my STAR CARE card.

I got it back when I was a paramedic student at Baystar Ambulance in San Mateo California. It was 1992. I always believed the original author was none-other-than EMS guru Mike Taigman. Mike had signed on to be the quality care guy at the fledgling service and I knew the cards had originated in his office.

The idea was simple. We can’t write a policy for eveything you may encounter in the field. Instead, use this guideline. If the decision you’re about to make passes these eight tests, we support you. NO matter what. Come hell or high water … we have your back.

It’s brilliant really. It’s the policy to end all policies. It’s the grand daddy algorithm. It’s the ultimate protocol.

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Written Protocol vs. Common Sense

Steve Valdez only wanted to cash a check. In retrospect it seems so simple. The check was written to him from his wife’s account at Bank of America. He had two forms of ID, both with photos. The address on the drivers license was the same as the ID on the check (printed by Bank of America.) Bank of America thought differently.

Here’s the rub. B of A has a written policy that states if you don’t have an account at their bank you need to leave a thumbprint. You’ve probably seen those by now. Either you dab your thumb in an ink blotter or you use the fancy thumb scanner. But Steve Valdez doesn’t have any arms. And based on his inability to make a mark with his non-existent thumb, B of A refused to cash the check.

Clearly the bank representative thought that following the rules was the safest option. Instead of considering the needs of the customer, interjecting common sense into the matter, taking on a wee bit of personal risk on behalf of the individual being served and making a simple accommodation, the bank manager stuck to her guns. Rules are rules. And now the story has been picked up by the AP news wire and it’s everywhere.

Don’t laugh. It could happen to you. We all operate under multiple sets of rules and regulations from our written protocols to our national scope of practice to our organizations policy manual. We all are expected to apply a set of pre-established rules to our jobs in EMS. The question is how we perceive those rules. Do they trump basic common sense?

Do the prohibit us from acting in the patients best interest? When are we allowed to forgo the rules? If we decide it’s only in emergencies … well, were bound to encounter a lot of those.

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Get Anyone to Go With You to The Hospital

I’m going to share with you a very powerful technique to convince just about anyone to go with you to the hospital, and I’m going to ask a favor of you. Please only use this technique in the patient’s best interest. This isn’t a technique to drag out when your service pressures you to increase transports or you’re not in the mood to call in for a proper refusal. This is a technique for when you really honestly believe that the patient needs to go, but they refuse.    -Steve

It’s an interesting contradiction in prehospital medicine. The people who don’t really need an ambulance insist on transport and the really sick folks refuse to go. Sometimes the people we could really help dig in their heals and just refuse to go. It’s frustrating. It can be maddening. And occasionally it means that we have to pull out our paper work and sign a potentially really sick patient out against medical advice. (AMA)

In these moments we implore the patient to reconsider, hand over the paperwork for signing and then we say something about calling us back if things change. Now let me give you one more technique to try before you pack up and walk away.

This is a simple, three-part technique. 

Step One: Establish a rapport with the patient. Hopefully you’ve been working on this from your first contact. Fair warning, don’t try to skip over this step. If you haven’t established a rapport with the patient this just isn’t going to work. The patient needs to trust you and be willing to consider what you say.

If you’re developing your patient rapport skills I recommend reviewing Connections, Patient Rapport Land Mines and You Can’t Give Away What You Don’t Have. You may even want to stop by Patient’s Define Their Emergencies.

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What Is The Good Samaritan Law?

The term “Good Samaritan” comes from the gospel of Luke. In the parable told by Christ, a Samaritan helped a Jew who had been beaten and robbed. At the time, the Samaritans and Jews were mortal enemies. Through the parable, Jesus attempts to redefine what it means to be a good neighbor.

Reading some recent conversations on the good Samaritan law in a few online forums, I’m reminded not of the biblical parable, but of the parable of the six blind men describing an elephant. Remember that one? One guy feels the side and thinks an elephant is like a wall, the other feels the tail and thinks an elephant is like to a rope? Initiating a discussion on the good Samaritan law in an online forum of EMTs is an invitation for confusion and scorn.

“It only applies to bystanders.”

“No it doesn’t! It only applies to EMS personnel.”

“And only if you’re off duty. Unless you’re a volunteer. And then only … no … wait.” And on and on.

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EMT Charged With Patient Abandonment

                          … It could happen to you

That’s what EMT Paul Casson of the Bronx is learning. On New Years Eve, Paul was waiting to drop off a five year old child at Lincoln Hospital. Per investigators, Paul got tired of waiting, so he decided to forge a signature on his run sheet and leave the child behind.

Apparently the child had non-life threatening injuries and Paul figured someone would be by shortly to take care of him. Now Paul is being charged with endangering the welfare of a child. Here’s the crazy part.

If he’s convicted, this guy could spend the next seven years in prison thinking about what it means to be an advocate for your patient. The good news is that most of us don’t need laws to tell us to take good care of people and protect them. But Paul’s story is certainly a good reminder.

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